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Weight change & associated health problems

Ideas about why some long term health problems are associated with being overweight

We talked with people who had been diagnosed with a variety of long-term illnesses that are associated with weight gain. Weight had often been a factor in the development of the illness and sometimes the effects of the condition, or the treatments involved, made it particularly difficult to manage weight.  

“All I can …. I’ve so far absorbed is the fact that if you eat less you will lose weight, and if you exercise more you will maintain weight, and that’s about as far as it goes” [Alan X, 48].

Although the relationship between consuming and burning calories was well understood, a long term health problem sometimes left people unsure about how to manage their weight. Here we look at people’s ideas about the relationship between weight gain and their long term health problems.
 

Being overweight didn’t worry David – that was until he was diagnosed with type 2 diabetes and heart disease.

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Age at interview: 71
Sex: Male
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What caused me to start? I think [whistle] obviously, being diagnosed diabetic was a watershed. In other words, realising that your lifestyle had, you know, what causes diabetes, realising that your lifestyle is having an adverse effect and that, for me, was compounded by the fact that these can blame the same thing for my heart condition. So that sort of stage, was quite a watershed.

Up until then, I’d been rather enjoying the fact that I could afford to eat well and you know, be the life and soul of parties and all that sort of thing.

I was aware that I was I was,

I know but,

I was a jolly fat man [laughs].

I was, I was generally aware that my weight was above average and that didn’t worry me a great deal. It didn’t interfere with my lifestyle. It didn’t affect my work. It didn’t, I ate well. I, I went diving and I went sailing and I was perfectly happy but I was overweight. I was enjoying myself. I was eating wonderful food. I could afford the lifestyle I liked and then somebody said, “Oh, you’re hyperglycaemic.” What does that mean? And people used to say, “Oh, you ought to stop smoking. You’re smoking too much.” I was enjoying life. I was thirty five, forty and I was living well, thank you very much. You know, tell me I’m fat, “yeah, I’m a bit overweight. Let’s go and have a steak” and.

Okay. So there was no.

I but the, what. I was aware that I was overweight. I knew that that was unhealthy but I was all right. I was diving. I was sailing. I was strong enough to manage a boat around the place. I was, it wasn’t interfering with my work. Worked well. It wasn’t until I was not given a trackside pass because of they were they were suddenly worried I might fall over on the on the track. And they said, “Go and see a doctor. You’re not well.” “What?”

And that was a shock.

And how were you feeling, at that time?
 
Fantastic.  [laughs]  Up until then.

Either directly, or indirectly, some health conditions increase the likelihood of gaining weight. Gaining weight was sometimes a side effect of the medicines they were prescribed to manage their illness. For example, Maxine felt that the steroidal injections she had to take for her joint problems had affected her metabolism and her ability to lose weight.
 

Lina explains how steroid treatment led her to gain weight and left her with the ‘moon face effect’.

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Age at interview: 49
Sex: Female
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So, regarding your weight, you, you, the main reasons for you is the medication that you have put on weight because of steroids and other medications that you take.

Absolutely, there’s no hundred per cent but everybody who knows me, family, friends, they said to me, ‘Oh wow, what’s happened?” and I’ve said, “Well since I’ve started taking steroids and medication I’m just, this is what I look like,” and anybody that takes steroids it happens to us all, we get this face, this moon face effect. And I said to them, “What it is, is your body tries to store fat in other places so it will shoot to your face, or the back bit of your neck or round your midriff area,” and unless I’m you know, killing it in the gym, it’s unfortunately is going to, that’s how I have to get used to looking like this because at the moment there’s isn’t going to be a way of me, to be able to burn off that amount, that much amount of fat and that much amount of calories in my current physical state, so I’m just noticed I was getting bigger and bigger and when I got to thirteen stone, I was like, ‘I can’t, I’ve got to try and do something.’ So hopefully, well not hopefully, it has, I have been losing weight. I’m, from 88 kilograms, I’m now 84.2.
 

Some diabetes treatments increase appetite and cause weight gain. Having hypothyroidism (also called ‘underactive’ or ‘low’ thyroid) can cause people to put on weight until it is treated. Joan had been very active with regular hill walking, gym and skiing, but the extreme tiredness and pain associated with her illnesses prevented her from staying active.
 

Joan describes her symptoms before being diagnosed with Hypothyroidism and Sjogren’s. At her heaviest she weighed twenty stone ten pounds.

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Age at interview: 57
Sex: Female
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I guess when I first started putting on weight I must have been thirty-nine. Don’t get me wrong, I was never really, really skinny, but I used to be fit. When I became eleven stone I was fat. I tried to keep my weight between ten and ten and a half. Did hill walking, hill climbing, skiing. I was really very active. Went to the gym. Then I became really, really tired. Was putting on weight really, really easily and that’s when I discovered I was hypothyroid. It’s, the hypothyroidism, over the years the dose has increased of thyroxin that I take. Shortly after that, the fatigue never ever went away, and I would say for about six or seven years, thereafter, was I had days where I could sleep on the edge of a knife, do you know, kind of struggled a wee bit at work with the tiredness, concentration was appalling. The GP did all my bloods and my inflammatory factors were really high and I seen the rheumatologist and he said, my GP thought it was Lupus. Seen the rheumatologist who said, “I’m ninety nine per cent sure that you’ve got Sjogren’s syndrome. He said, “Your tongue’s really coated,” he said, “how’s your eyes?” and I said, “nothing wrong with my eyes.” He said, “Can you cry easily?” And at that time if I was watching a sad film, yeah absolutely. So, he said to me, “Look, there’s no active treatment for it just now but I will see you again.” Two years later, seen him again. My eyes were dreadful, really dry, really inflamed. Became really itchy. My tongue was much worse. Was getting pains in my joints for no apparent reason… I and he seen me, and he said, “Oh you’ve definitely got Sjogren’s,” and he followed me up. He started me on hydroxychloroquine which is used to treat malaria but it’s also used to treat inflammatory disorders. So I was started on 200 twice a day and was pretty good for a couple of year on that. He then retired, and I’ve seen another doctor in the NHS at [hospital] and she said, “Your inflammatory factors are still really high.” At this time, I was getting pains, especially my shoulders and hips and couldn’t really do any exercise. Went to the gym and couldn’t lift a thing. Became a bit despondent and I was putting on weight on the, I think my weight eventually went up to about twenty stone ten pounds.

 

Paul Y describes how his diagnosis of sleep apnoea and type2 diabetes came about and explains the relationship between his sleep apnoea, tiredness and weight gain.

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Age at interview: 55
Sex: Male
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I had always snored since, since I was a young man. If anybody shared a room with me they said, “Oh, you’re really loud.” But I don’t think that other than trying, I’d never gone for, I don’t think I’d ever sought a diagnosis for that just maybe tried some of the sort of sleep breathing, sorry the, the sort of nasal opening strips. I had never realised that it was, it was having such an effect on me. But, but the lack of deep sleep just meant that I had less and less energy. So the two, so the eventual diagnosis of, of Type II diabetes which I think was around 2007 was, was certainly linked to, to sleep apnoea because over time I just had less and less energy because I was getting very, very little sleep but not realising it because it’s such a gradual process that and, and of course having, having that little energy, you just, you know, you’re not inclined to exercise and the job I was doing virtually seven days a week in my business was sitting, was principally sedentary. So even though, you know, I lived in a place where, and I still, still went out for, for a walk with my dogs at the time, I was less, I was doing less and less exercise but that was, it was almost imperceptibly small changes to, to, to my last job so I didn’t realise that I was, I was getting ill.

…It was when, when I eventually got a referral the, you wear a monitor for the night and it basically said, ‘Well you know, you wake up every forty seconds.’ [Laughs.] You’re not consciously waking up…

No.

…but you don’t get any deep sleep at all. This is a, you know, that’s quite severe, you know, and falling asleep at the wheel and all those kinds of things. That’s severe sleep apnoea. You need to do, you need to do something about that.

How was your weight at that time?

So, it had just crept up. I mean I’d always been fairly big. Played, played rugby, went, went running, but, you know, I’m big anyway but I think, yes, just, just crept up. So it’s probably, probably 110 kilos something like that.

So, they diagnosed you?

So, two separate diagnosis obviously one for sleep apnoea and I’ve got my sleep app machine and have used it ever since and love it. There was, you know, an almost instant change there. But yeah, when I’d gone to the doctors, you know, one of the things they did was, was do a blood sugar test and just say, “Okay, right you’ve, you’ve, there isn’t any doubt, you’ve got type 2 diabetes.”

Yes if your weight creeps up, one of the ways you’re more likely to get sleep apnoea if you’re, if you’re carrying weight because the weight, if you’re collar size increases I mean that’s the simple measurement that they’ll take, they’ll say you’re more likely to get sleep apnoea because your throat will constrict and, you know, less air through into your lungs and less oxygen to your brain, so [laughs] yeah, so it can develop. So yes, there is a relationship, so you’re more likely to get sleep apnoea if, if you’re heavy, as it happened, I think I’ve probably always, always suffered from a degree of it but whether it, but whether it worsened I don’t know because I didn’t, I didn’t know until I wore that monitor that I was waking up every forty seconds. But that could have been the case for years, you know, years and years.
 

Fatigue, pain or reduced mobility, meant that some people were less able to exercise or go out. John reflected on the increasing difficulties he experienced due to his heart disease and back pain. The ‘vicious circles’ involved are discussed further in ‘The vicious circles of chronic health conditions and being overweight’.
 

John Y had entered a self-perpetuating circle between being overweight and heart disease.

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Age at interview: 80
Sex: Male
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I think it is a circular question.

What came first? [Laugh]

Yeah the heart attack came first and then that was controlled and my. I was able to do all the exercise and things so the weight didn’t go up. Then the second heart attack came on and shortly after the second heart attack the back problems started. So I wasn’t able to do the exercise regime that I’d done on the previous ones. And then the back problems got worse and the kidney problem came in and the then the third set of heart attacks came on. And the problems with the exercising increased. So I think it was kind of going as a self-perpetuating circle. And if I could, if I could brave that but the only place that it is breakable is the problems with the back with the pains that stop me doing the other things.

Some people we talked with described how mental health problems had led them to gain weight. Stress, anxiety, and depression could contribute to binge eating, over-eating, or comfort eating. Ria has depression and binge eats; about four years ago she was diagnosed with non-alcoholic fatty liver disease.

Often, people described how their weight was affected by multiple factors which all related to each other, such as physical illness, medication side effects, weight gain, and low self-esteem.
 

Following a mental health breakdown, Heidi was sectioned and started taking anti-psychotic and anti-depressant drugs. This led her to gain about four stone in weight.

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Age at interview: 50
Sex: Female
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I’m fifty years old and when I was about eighteen I first started on antidepressants because I had a very low mood due to the death of my, my Nanna. I think since then I’ve gradually put on a little bit of weight and because in 1997 I started on, I had a breakdown and was sectioned, and I was started on anti-psychotics. Now that then to me was my first ever major weight gain. I must have put on about four stone due to these anti-psychotics and anti-depressants.

Some weight increases were gradual and felt normal (for example with pregnancy, menopause, aging or a more sedentary lifestyle) until there was a health crisis or surprise diagnosis.
 

David’s realised that his lifestyle and work had contributed to him being overweight.

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Age at interview: 71
Sex: Male
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If I look back at what I was eating back then, you know, such, I couldn’t do it now. I couldn’t face it. I was definitely overeating. A lot of it was entertaining, a lot of it was work related.

So it was overeating and eating the things that do not agree with you or.

I think it was a lot of a lot of restaurant eating.

Okay.

And it it’s, I’ve, the sort of places I went to anyway, it was difficult to get a low cal, it’s easier now than it was then, to be quite honest, but, you know, there was a lot there was a lot of high calorie food involved in the sort of food that I was eating, whereas now I rarely eat such high calorie meals.

Then then I started studying, working in an office, spending more time sitting down. I still exercised because I couldn’t afford, you know, I had to had to ride a bike to work and I had to, didn’t have a lot of money still. As I as I got more wealthy, I exercised less. I ate more and more rich foods and, by the time I was middle aged, I was eating too much and not exercising enough and, by the time I was late middle aged, I was paying for it. And that’s, that’s basically it, so it was it was lifestyle.

Genetics was mentioned by several people when considering why people are overweight. For some people, this explained why being overweight ran in their family, or why certain members of the family were overweight while others were not. Ellie  said that  her three sisters and aunts were all overweight and “there’s got to be a link somewhere”. People didn’t always know why they had put on weight, and those who felt they    had been “born big” could feel that there was some inevitability about their size

A few people had experienced weight gain with one illness and weight loss with another for instance, gynaecological and hormonal changes led Myra, who had always ‘struggled with weight’, to experience both.
 

For Myra, Endometriosis led to weight gain while a condition called Pheochromacytoma led to weight loss.

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Age at interview: 65
Sex: Female
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I was really healthy until I was about thirty and then I had some gynaecological problems and they discovered I’d got endometriosis. I mean, I have always struggled with my weight to a degree. Very sweet tooth, you know, comfort eating. All the usual things. [m] But they discovered I’d got endometriosis and that involved sort of all sort of hormonal treatments which weren’t very nice and that, I think that probably had an effect on my weight. I had, later on, I had breast cancer and had to have chemotherapy which was really hard and I think that probably, I think that probably, I think the chemo if I remember rightly I did, did put on weight because you don’t know what you want to eat, and you just feel sick, so you just eat, probably eat all the wrong things.

In, about ten years ago, they discovered I’d got a really rare condition called Pheochromacytoma which is difficult to say, and I had to have both of my adrenal glands removed. Prior to being diagnosed, I couldn’t understand why I was suddenly able to control my weight and it was really, I was really not having a problem and it was because the, the glands, the tumours were producing loads of adrenaline, so I was just on a, on a high and really, and, you know, so my body was really going at 90 miles an hour. And my weight was really good, you know, and I had other, all sorts of, I used to get really, really hot and really, horrible effects but my weight was really good.

See Also: Environment and cultures impact on weight.
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